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Covers the various types of prostatitis, including acute bacterial, inflammatory, noninflammatory, and chronic pelvic pain syndrome. Covers symptoms for each type. Discusses treatment for each type. Covers lifestyle changes, medicines, and surgery.

Prostatitis

Topic Overview

What is prostatitis?

Prostatitis is swelling or
infection of the
prostate gland. It often hurts. The
prostate gland sits just below a man's bladder and makes part of the fluid for
semen. In young men, the prostate is about the size of
a walnut. It usually grows larger as you grow older.

There are
several types of prostatitis. They vary based on how long a man has had the
problem and what kind of symptoms he has.

What causes prostatitis?

Sometimes prostatitis is
caused by bacteria, but often the cause is not known.

What are the symptoms?

Symptoms of long-term
(chronic) prostatitis are often mild and start slowly over weeks or months.
They may include:

An urge to urinate often. But you may pass
only small amounts of urine.

A burning pain when you
urinate.

A problem starting the urine stream, urinating in waves
rather than in a steady stream, urine flow that is weaker than normal, and
dribbling after urinating.

Waking up at night to urinate
often.

A feeling of not completely emptying your
bladder.

Pain in your lower back, in the area between the
testicles and anus, in the lower belly or upper thighs, or above the pubic
area. Pain may be worse during a bowel movement.

Some pain during
or after ejaculation.

Pain in the tip of your penis.

Symptoms of acute prostatitis are the same, but they
start suddenly and are severe. They may also include a fever and chills.

Some men may have no symptoms.

How is prostatitis diagnosed?

A doctor can often
tell if you have prostatitis by asking about your symptoms and past health. He
or she will also do a physical exam, including a
digital rectal exam. In this test, the doctor puts a
gloved, lubricated finger in your rectum to feel your prostate. You may also
need blood and urine tests to find out which type of prostatitis you have or to
look for another cause of your problems.

How is it treated?

Prostatitis caused by bacteria
is treated with antibiotics and self-care.

Home treatment includes
drinking plenty of fluids and getting lots of rest. Taking
over-the-counter pain relievers can also help.

Your doctor may prescribe medicine to control pain and reduce swelling.
He or she may also prescribe medicine to soften your stool and relax your
bladder muscles.

Symptoms

The symptoms are similar for all forms of
prostatitis, with the exception of
acute prostatitis.

Symptoms of chronic prostatitis may include:

A frequent urge to urinate, although you may
pass only small amounts of urine.

A burning sensation when
urinating (dysuria).

Difficulty starting urination, interrupted
flow (urinating in waves rather than a steady stream), weaker-than-normal urine
flow, and dribbling after urinating.

Excessive urinating at night
(nocturia).

A sensation of not completely emptying the
bladder.

Pain or discomfort in the lower back, in the area between
the testicles and anus, in the lower abdomen or upper thighs, or above the
pubic area. Pain may become worse during a bowel movement.

Pain or
vague discomfort during or after ejaculation.

Pain in the tip of
the penis.

With acute prostatitis, symptoms are severe, come on
suddenly, and include fever and chills. Signs of
chronic bacterial prostatitis may be milder and come
on suddenly or gradually over weeks or months, and the symptoms may come and
go. Symptoms alone cannot be used to determine the type of prostatitis you
have.

What Happens

Prostatitis,
especially if it continues for a long time, can cause
stress,
anxiety, and
depression.

Chronic prostatitis

Chronic prostatitis often gets better over time without
serious complications. But the symptoms sometimes return
unexpectedly.

Acute prostatitis

Men with
acute prostatitis have severe pain and fever. Most men recover fully when treated with antibiotics.
Delaying treatment increases the risk of complications, such as
sepsis or an
abscess in the prostate.

If you have had
chronic bacterial prostatitis, you have an increased
chance of developing it again.

When To Call a Doctor

Contact your doctor immediately if you have sudden fever, chills, and
urinary symptoms, such as pain or burning with urination or blood or pus in the
urine. These symptoms may point to acute prostatitis.

Call your doctor if you
have:

Urinary symptoms and persistent pain in the low
back,
scrotum, penis, or the area between the scrotum and
anus, or if you have pain with ejaculation or with a bowel
movement.

Problems urinating,
such as excessive nighttime urination, trouble starting urinating, decreased
urinary stream, or frequent urination that is not related to drinking lots of
fluids.

Watchful waiting

Most men will have some discomfort in their
prostate (prostatitis) at some time during their lives. If you
do not have a fever and chills or extreme pain, you may try home treatment for
a few weeks. Take nonprescription pain medicines, such as aspirin, ibuprofen,
or acetaminophen, to relieve pain. But if your urinary symptoms and pain
continue, be sure to see a doctor.

Who to see

Health professionals who can evaluate and treat your
prostatitis include:

Exams and Tests

If your doctor suspects
that you have
prostatitis, he or she will begin with a complete
medical history and physical exam. The type of
prostatitis that you have cannot be determined solely from your history and
symptoms. Your doctor will do tests to find out the cause of your
prostatitis.

Acute prostatitis is the least common
type but the easiest to diagnose. If acute prostatitis is suspected, a
urine culture will be done to test for the presence
and type of bacteria.

If your history and physical exam show that
you do not have acute prostatitis, a
pre- and post-massage test (PPMT) or
expressed prostatic secretions test may be done to
find out which type of prostatitis you have. An expressed prostatic secretions
test is not done if acute prostatitis is suspected, because when the prostate
is inflamed or infected, massaging it to obtain a sample for tests is very
painful and possibly dangerous. Some doctors believe that
massaging an infected prostate increases the risk of developing a bacterial
infection of the blood (septicemia).

More tests
may be needed if:

Your symptoms do not improve with
treatment.

You continue to have prostate infections.

The symptoms could be caused by
bladder or
prostate cancer.

Your doctor
suspects you have a complication related to prostatitis, such as an
abscess.

Treatment Overview

Treatment for
prostatitis usually begins with taking an antibiotic
for several weeks. If you begin to feel better, you may have to take the
medicine for 2 to 3 months. If you do not get better while taking
antibiotics, more tests may be done.

Chronic prostatitis

You may need to try more than one treatment. There isn't a standard treatment that works well for all men.

Antibiotics are tried first. If your symptoms
do not improve, treatment with these medicines is usually
stopped.

Muscle relaxants and
alpha-blockers may be used if muscle spasms are
causing pain or problems urinating.

5-alpha reductase inhibitors, medicines that slow
the growth of the prostate, may be used.

Physical
therapy, exercise, or massage therapy may help some men.

Counseling,
biofeedback, or relaxation techniques may help reduce
stress that is contributing to the pain

Certain plant extracts, such as bee pollen extract (Cernilton) or quercetin (Prosta-Q) may provide some relief.1

Acute prostatitis

Treatment for
acute prostatitis is aimed at curing the infection and
preventing complications. Acute bacterial prostatitis is treated with
antibiotics, pain and fever medicine, stool softeners, fluids, and
rest.

If you are unable to urinate or need
intravenous antibiotics, you may be admitted to a
hospital for a short time for treatment.

Most men get better quickly. Treatment (usually at home) lasts for 4 to 6 weeks.

Chronic bacterial prostatitis

Treatment for
chronic bacterial prostatitis is aimed at curing the
infection and preventing complications. Antibiotics are given for 6 to 12
weeks. Long-term antibiotic treatment may be needed if the infection
returns.

Infected prostate stones (prostatic calculi) can make the infection more
difficult to cure. They may need to be surgically removed.

Surgery may be needed if urinary tract problems, such as
narrowing of the bladder neck or urethra, are causing the
prostatitis.

Surgical removal of the prostate (prostatectomy) for repeated infections is rarely used
and is used only as a last resort.

Sit in a tub of warm
water with the water just covering your buttocks, or try a
sitz bath.

Take care of yourself when you
have an infection. Get plenty of rest, and drink lots of fluids. This will make
you feel better and may speed your recovery.

Eat plenty of
high-fiber foods, such as fruit, vegetables, and whole-grain breads and cereal. And drink enough water to avoid constipation. Straining to pass a bowel
movement may be very painful when your prostate is inflamed, so use a stool
softener if needed.

Be physically active. Sitting for long periods of time can make this problem worse. But exercise, especially aerobic exercise, seems to help.2

Avoid alcohol, caffeine, and spicy foods such
as hot peppers, chili, pickles, and salsa, especially if they make your
symptoms worse.

Medications

Treatment of
prostatitis usually begins with antibiotics and
possibly other medicines to relieve symptoms. If you begin to get better, you
may have to continue taking antibiotics for 2 to 3 months. During this time, be sure to take the antibiotics as prescribed. If you do not begin to get
better while taking medicines, your doctor may want you to have more
tests.

Medicine choices

Chronic prostatitis

Chronic prostatitis is usually treated first with
antibiotics based on the possibility that an infection was missed during
testing. But experts advise against long-term treatment with antibiotics
unless an unusual bacterial infection is suspected.

Medicines
that may be used to treat chronic prostatitis include:

Antibiotics. If
the symptoms begin to improve, it is possible that an undiagnosed infection is
responsible for the symptoms.

Medicines that relax muscles throughout the body
(muscle relaxants) or that relax muscles in the
prostate (alpha-blockers).

Medicines that slow the
growth of the prostate (5-alpha reductase inhibitors).

Medicines
that reduce anxiety, such as benzodiazepines. These medicines
work best when combined with counseling.

Medicines that are used for chronic pain (anticonvulsants).

Acute and chronic bacterial prostatitis

Antibiotics are central to treating
acute or
chronic bacterial prostatitis. Your doctor may
prescribe certain antibiotics based on your medical history, symptoms, and
other factors such as your age. Other medicines may also be used to help
control symptoms, including:

Chronic bacterial prostatitis may require long-term
antibiotics, especially if the symptoms return. Some men need treatment with
low doses of antibiotics over a long period to control infection and prevent
repeated
urinary tract infections (UTIs).

Surgery

Surgery for
prostatitis may be needed to treat
chronic bacterial prostatitis that does not respond to
long-term antibiotic treatment and that causes repeated
urinary tract infections. Surgery may be done to
remove part of the prostate or to remove infected prostate stones (prostatic calculi).
But this does not always cure the infection, and it may make the symptoms
worse. Surgery is typically done only if all other treatments have
failed.

Surgery choices

Surgical removal of part of the prostate to remove prostate
stones or to treat an
infection that does not respond to antibiotic treatment is called
transurethral prostatectomy.

Other Treatment

Prostatic massage

Prostatic massage for
prostatitis ("milking" of the prostate by a doctor) is an old treatment that many doctors are beginning to use again
because medicines do not always successfully cure prostatitis.

To massage your
prostate gland, the doctor inserts a
lubricated, gloved finger into your rectum and presses several times on your
prostate. This may need to be done 2 or 3 times a week. Why this works is not
certain, but it is believed that the massage helps open blocked ducts in the
prostate, improving circulation and antibiotic penetration into the
prostate.

Prostatic massage is not done for acute prostatitis,
because it could cause the bacteria to spread from the prostate and cause a
wider infection (sepsis).

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